36C25719R0027-0001_RFP Amendment - Conformed Copy.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. DUNS: DUNS+4:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 96

36C25719R0027-0001 02-06-2020

Juan Martinez 210-694-6303 03-24-2020

11:59 PM CT

36C257

Department of Veterans Affairs

VISN17 Network Contracting Activity

7400 Merton Minter Blvd. (10N17/90C)

San Antonio TX 78229

X 100

X

621610

$16.5 Million

N/A

X

Per task order.

36C257

Department of Veterans Affairs

VISN17 Network Contracting Activity

Attn: Juan Martinez

7400 Merton Minter Blvd. (10N17/90C)

San Antonio TX 78229

Government Purchase Card (GPC)

As cited on individual task orders.

See CONTINUATION Page

The VA intends to procure Home Oxygen Services for VISN 17 in accordance with the Performance Work Statement.

Please see Attachment 2 for the Price Worksheet. All prices must be filled-in on all tabs for interested areas.

One or more Indefinite Delivery Indefinite Quantity (IDIQ) contracts may be written from this solicitation.

See CONTINUATION Page

X X

X 1

36C25719R0027-0001

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2020)

C.2 52.216-18 ORDERING (OCT 1995)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ...49

C.7 52.222-42 STATEMENT OF EQUIVALENT RATES FOR FEDERAL HIRES (MAY

2014)

C.8 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.9 52.252-6 AUTHORIZED DEVIATIONS IN CLAUSES (APR 1984)

C.10 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (OCT 2019)

C.11 VAAR 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-

OWNED SMALL BUSINESS SET-ASIDE (JUL 2019) (DEVIATION)

C.12 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND

COMPLIANCE (JUL 2018)

C.13 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.14 VAAR 852.247-71 DELIVERY LOCATION (OCT 2018)

C.15 VAAR 852.247-72 MARKING DELIVERABLES (OCT 2018)

C.16 VAAR 852.247-73 PACKING FOR DOMESTIC SHIPMENT (OCT 2018)

C.17 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.18 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT

2015)

E.2 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.3 52.209-11 REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT

TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (FEB 2016)

E.4 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)

E.5 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.6 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS (DEC 2019)

E.7 52.216-1 TYPE OF CONTRACT (APR 1984)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.10 52.252-5 AUTHORIZED DEVIATIONS IN PROVISIONS (APR 1984)

E.11 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE

RESOLUTION (OCT 2018)

E.12 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.13 EVALUATION FACTORS AND SUBMISSION INSTRUCTIONS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Office 36C257

Juan Martinez

Department of Veterans Affairs

VISN17 Network Contracting Activity

7400 Merton Minter Blvd. (10N17/90C)

San Antonio TX 78229

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[X] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment

Requests.

Government Purchase Card (GPC)

As cited on individual task orders.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 PERFORMANCE WORK STATEMENT

1. VISN 17 desires to establish one or more base year with four one (1) year option period

Home Oxygen Indefinite Delivery-Indefinite Quantity (IDIQ) contract(s) for the stations listed below. (See “Term of the Contract” on page 34 for additional details). These contracts will cover

VISN 17 as outlined below. No more than one contract per station. Contracts may include all or some of the stations. Offeror not limited to the amount of stations they wish to propose on.

504 Amarillo VAHCS

6010 Amarillo Boulevard, West

Amarillo, TX 79106

519 West Texas VA HCS - Big Spring, TX 300 Veterans Blvd.

Big Spring, TX 79720

549 North Texas VHCS - Dallas, TX 4500 South Lancaster Road

Dallas, TX 75216

671 South Texas VHCS - San Antonio, TX 7400 Merton Minter Blvd.

San Antonio, TX 78229

674 Central Texas Veterans Health Care System - Temple, TX 1901 Veterans Memorial Drive

Temple, TX 76504-7451

740 Texas Valley Coastal Bend HCS 2601 Veterans Drive

Harlingen, TX 78550

756 El Paso, TX 5001 North Piedras Street

El Paso, TX 79930-4211

Station ID Facility (Ordering Activity) Address

SERVICES AND GEOGRAPHIC AREA

The Home Oxygen Services contractor will provide a comprehensive Home Oxygen program furnishing all non-personal services, personnel, equipment, tools, supplies, vehicles, training, reports, and facilities necessary for the provision of Home Oxygen services for eligible patients

(Veterans) of the VISN 17 area. Performance of this contract will involve interaction with

Veteran patients and their Caregivers. Contractor personnel will also interact with the COR and other members of the VISN 17 Prosthetics and Sensory Aid Services (PSAS) and Respiratory

Therapy Department during the patient’s Home Oxygen therapy continuum of care. This contract may be impacted by changes in regulation, legislation, or medical service policy initiatives identified by VA national, regional, or local directors. For each listed VA Health Care

System (HCS), contractor shall provide setup, installation, and management of Home Oxygen and/or Ventilation services to any Patients that are treated at the main VA Medical Center

(VAMC) and all Community Based Outpatient Clinics (CBOCs) and Outpatient Clinics (OCs) supported therein (Clinic of Jurisdiction/Primary Service Area COJ/PSA), regardless of their physical location. The listing of counties in the PSA for each VA HCS does not exclude the provision of services in other counties. This includes Patients who reside near bordering state’s catchment areas but prefer to be seen by a VISN 17 VA HCS provider. Home Oxygen services under this contract will be provided in the following geographic jurisdictions of the VISN 17 —

<> VA South Texas Health Care System (671)

7400 Merton Minter Blvd.

San Antonio, Texas 78229

South Texas facilities are comprised of the following (46) Texas Counties:

Atasocosa, Bandera, Bee, Bell, Bexar, Blanco, Brooks, Comal, Concho, Crockett, De Witt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Hays, Jackson, Karnes, Kendall, Kerr, Kimble, Kinney, La Salle, Lavaca, Live Oak, Maverick, McCulloch, McMullen, Mason, Matagorda, Medina, Menard, Pecos, Real, Schleicher, Sutton, Terrell, Uvalde, Val

Verde, Victoria, Wharton, Wilson, Zavala

<> VA Central Texas Health Care System (674)

1901 Veterans Memorial Drive Temple, Texas 76504

Central Texas facilities are comprised of the following (38) Texas Counties:

Anderson, Bastrop, Bell, Bosque, Brazos, Brown, Burleson, Burnet, Caldwell, Cherokee, Coleman, Comanche, Coryell, Erath, Falls, Fayette, Freestone, Gonzales, Hamilton, Hays, Henderson, Hill, Houston, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Navarro, Robertson, San Saba, Somervell, Travis, Williamson

<> VA North Texas Health Care System (549)

4500 South Lancaster Road Dallas, Texas 75216

North Texas facilities are comprised of the following (50) Texas and (4) Oklahoma Counties:

Counties in Oklahoma – Bryan, Choctaw, Marshall and McCurtain

Counties in Texas – Archer, Baylor, Bowie, Callahan, Camp, Cass, Clay, Collin, Cooke, Dallas, Delta, Denton, Eastland, Ellis, Fannin, Franklin, Grayson, Gregg, Harrison, Henderson, Hood, Hopkins, Hunt, Jack, Johnson, Kaufman, Lamar, Marion, Montague, Morris, Palo Pinto, Panola, Parker, Rains, Red River, Rockwall, Rusk, Shackelford, Smith, Stephens, Tarrant, Throckmorton, Titus, Upshur, Van Zandt, Wilbarger, Wise, Wichita, Wood, Young

<> VA Texas Valley Coastal Bend Health Care System (740)

2601 Veterans Drive Harlingen, Texas 78550

Texas Valley Coastal Bend facilities are comprised of the following (16) Texas Counties:

Aransas, Calhoun, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata

<> AMARILLO VA HEALTH CARE SYSTEM (504):

6010 Amarillo Blvd West Amarillo, TX 79106

Amarillo facilities are comprised of the following (45) Texas, (05) New Mexico and (02)

Oklahoma Counties:

COUNTIES IN TEXAS: Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collinsworth, Cottle, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Foard, Garza, Gray, Hale, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Hutchinson, Kent, King, Lamb, Lubbock, Lynn, Moore, Motley, Ochiltree, Parmer, Potter, Randall, Roberts, Sherman, Stonewall, Swisher, Terry, Wheeler, Yoakum.

COUNTIES IN NEW MEXICO: Colfax, Curry, Harding, Quay, Union.

COUNTIES IN OKLAHOMA: Cimarron, Texas.

<> WEST TEXAS VA HEALTH CARE SYSTEM (519):

300 Veterans Blvd Big Spring, TX 79720

West Texas facilities are comprised of the following (42) Texas and (01) New Mexico Counties:

COUNTIES IN TEXAS: Andrews, Borden, Brewster, Callahan, Coke, Crane, Crockett, Culberson, Dawson, Ector, Fisher, Gaines, Glasscock, Haskell, Howard, Hudspeth, Irion, Jeff

Davis, Jones, Loving, Lynn, Martin, Midland, Mitchell, Nolan, Pecos, Presidio, Reagan, Reeves, Runnels, Schleicher, Scurry, Shackelford, Sterling, Stephens, Taylor, Terrell, Tom Green, Upton, Ward, Winkler.

COUNTIES IN NEW MEXICO: Lea.

<> EL PASO VA HEALTH CARE SYSTEM (756):

5001 N. Piedras Street El Paso, TX 79930

El Paso facilities are comprised of the following (04) Texas and (07) New Mexico Counties:

COUNTIES IN TEXAS: Culberson, El Paso, Hudspeth, Reeves.

COUNTIES IN NEW MEXICO: Dona Ana, Eddy, Grant, Lincoln, Luna, Otero, Sierra.

From time-to-time, the number of Veterans served by this contract will change. VISN 17 currently serves an estimated 6,868 oxygen-using patients, an estimated 55 ventilator patients and an estimated 8 non-sleep related CPAP/BiPAP/NIV/Ventilator/Oxygen patients. The volumes or amounts shown in the solicitation are estimates only. The Government is not obligated to any specified number of products and/or services but shall be obligated to provide payments for all items/services requested in accordance with the contract. The task orders will be for the actual requirements of the VA as ordered by the VA during the life of the contract. The Contracting

Officers Representative (COR) or designated ordering officers will provide the Contractor with notification to initiate individual beneficiary service requirements, including the beneficiary’s oxygen prescription, ventilator prescription, equipment, supplies, and services to be provided including date and place of delivery. The Contractor will confirm receipt of the request

(prescription) within two working hours of notification; the COR or designated ordering officers will also provide notification of VA initiated discontinuance of service. The notification may be made orally but will be confirmed in writing within two (2) working days. The prescription will include the authorizing physician’s signature.

El Paso, Amarillo, and West Texas VHCS are under a separate contract until 10/31/2021.

These facilities will not be active on any new IDIQ until 11/01/2021. As such, if these three stations are combined with any other of the stations, El Paso, Amarillo and West Texas will only be on contract for the period of performance remaining on the awarded IDIQ.

2. Veterans with Computerized Patient Record System (CPRS) prescription for an oxygen concentrator (not the transfill system) shall be provided with an appropriate non-electrical backup system consisting of a compressed gas source and regulator with stand, humidifiers, cannulas/mask for use during the event of a power failure or mechanical problem and necessitating the use of the backup cylinder. The cost for the above-mentioned backup system shall be borne by the Contractor. The cost of replacement equipment damaged, lost, or misplaced not through beneficiary’s negligence shall be borne by the Contractor. Signed documentation by the patient/caregiver is required if the patient declines the oxygen back-up system. Documentation of refusal is submitted to the clinical home oxygen coordinator same day and a copy included as part of monthly billing.

3. In accordance with the home oxygen prescription received from the VA Medical facility, the

Contractor shall provide the beneficiary with the following supplies:

a. Humidifiers and water traps when deemed necessary. The number of humidifiers must be sufficient to ensure that they are not depleted between re-supply visits. The number of traps will be based on the patient’s flow rate.

b. Disposable oxygen cannulas on hand for a change once weekly in 4-foot and 7-foot lengths for concentrator and portable cylinders with a one change supply in reserve at all times until the Contractors next scheduled visit based upon prescription and equipment type.

c. Disposable masks for change weekly with a one change supply in reserve at all times

(when masks are prescribed in lieu of nasal cannulas).

d. 25 ft. and 50 ft. of oxygen connecting tubing with swivel connectors shall be replaced every two weeks with an equivalent section of tubing in reserve at all times (to be included in initial setup) until the Contractors next scheduled visit. All tubing must be colored and contrast with environmental surroundings/flooring to prevent falls/trips.

e. Trach Collar and accessories (e.g. tubing) with a supply on hand allowing for change daily or more frequently if indicated by patient needs and a supply in reserve at all times until the Contractors next scheduled visit.

f. Safety holders (plastic or metal) shall be provided at no charge for all Veterans with a prescription for four (4) or more cylinders.

g. FireSafe/FailSafe valves to decrease likelihood of fire if Veteran or family members are smoking around oxygen. Two valves (bi-directional only) shall be provided per oxygen source (concentrator and mobile conserving device) when Veteran is initially set up with home oxygen (one at the patient end and one at the oxygen source). Veteran is to be advised how to remove and reapply the valves when changing their tubing. Replacement valves are to be provided if patient inadvertently disposes of the valves when changing tubing. Re-education shall occur on proper reapplication of the valves when tubing is replaced. This replacement cost will be extended to the VA at CLIN pricing. (Valves shall be replaced at the end of their expected life per manufacturer’s guidelines or when actuated or involved in a fire.)

h. Veteran/family and/or caregiver educational materials to include use of equipment, contractor service number, and emergency numbers in the event of equipment malfunction will be provided. All equipment will be labelled with contractor’s name and emergency contact information.

4. Contractor shall provide the beneficiary with all necessary ventilator supplies as established by the Clinical Ventilator Coordinator to fill the prescription.

5. Home visits are required when a new patient is enrolled into the VISN 17 Home Respiratory Care Program. This first visit is referred to as an Initial Set up which should be accomplished immediately but no longer than 24 hours for oxygen patients (unless mutually agreed upon by Contractor/COR/Veteran/Caregiver/Clinical Home Oxygen Coordinator) after time of notification by the Clinical Home Oxygen Coordinator/COR with provision of complete patient information by the VA. The VA reserves the right to obtain the service from another source and to charge the Contractor with any excess cost that may result from it, if the Contractor is unable to meet the 24-hour response time. New Set-Up will include a monthly visit for the first 3 months by a Registered Respiratory Therapist to ensure patient is compliant with equipment and equipment is working properly. At times, the VA may require set-up in less than 24 hours which will be considered an emergent basis. These occurrences shall be approved by the Clinical Home Oxygen Coordinator, COR and/or designee only.

6. Home visits are required by a Respiratory Therapist when a new ventilator and/or CPAP/BiPAP/NIV/Ventilator patient is identified. The first visit is referred to as Initial Set up which should be accomplished immediately but no longer than 4 hours (unless mutually agreed upon by Contractor/COR/Veteran/Caregiver/Ventilator Clinical Coordinator) after time of notification by the Clinical Ventilator Coordinator/COR with provision of complete patient information by the VA.

The VA reserves the right to obtain the service from another source and to charge the Contractor with any excess cost that may result there from, if the Contractor is unable to meet the 4-hour response time. Contractor will perform the initial ventilator/CPAP/BiPAP setup in the hospital and/or home as directed by the VA. Follow up will occur between Contractor and patient or caregiver 24 hours after set-up, 72 hours after set-up and one week after initial set up. All follow up documentation will be provided to the Clinical Ventilator Coordinator. Local power company will be notified by the Contractor of the patient being home with a life support system. This is verified on the setup documentation as to time/date, power company name, number of the power company and the power company employee notified.

7. The Contractor shall provide switch-outs during the transition period of a new contract award in accordance with FAR 52.237-3, Continuity of Services, by staff with documented competency training on the manufacturers recommended assembly, use, and maintenance of the equipment used under this contract. All beneficiary switch-outs will be accomplished within the time frame established (as soon as possible after award, but not to exceed 90 days). Failure to perform the switch-outs as specified will result in a forfeit of payment to the provider currently used for every day thereafter until switch-out is complete. Payments will be assessed based on that providers established rate and prorated from setup date.

8. POLICIES AND PROCEDURES

The Contractor shall conform to all issues addressed in the VA Medical Staff By-laws and the current versions of:

• VHA Handbook 1173.13, Home Oxygen Respiratory Care Program

(http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=349)

• VHA Directive 2006-021 Reducing The Fire Hazard Of Smoking When Oxygen

Treatment Is Expected

(https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1407)

• Joint Commission Home Care Standards regarding equipment management within the patient’s home environment National Patient Safety Goals ref. NPSG.15.02.01

(https://www.jointcommission.org/assets/1/18/S1_NPSG.15.02.01.pdf).

9. WORK HOURS

The services covered by the contract shall be furnished by the Contractor as defined herein:

At a minimum, Contractor will provide services for Initial Set ups and scheduled visits, Monday through Friday from 8:00 a.m. through 6:00 p.m. Patient visits are required as indicated per clinical prescription and equipment type, unless the Clinical Home Oxygen Coordinator/COR determines a different time is required by their healthcare system.

VA observes the ten (10) Federal holidays listed below. Scheduled clinic appointments will not be available at VA during these holidays. Those holidays are:

New Year’s Day Labor Day

Martin Luther King’s Birthday Columbus Day

President’s Day Veteran’s Day

Memorial Day Thanksgiving Day

July 4th Christmas Day

It should be noted that if a holiday falls on Saturday, it is observed on Friday. If a holiday falls on Sunday, it is observed on Monday. There may be occasions when a new set up will be http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=349 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1407 https://www.jointcommission.org/assets/1/18/S1_NPSG.15.02.01.pdf necessary on a weekend or holiday. CLIN 26 and/or CLIN 27 will be used on these occasions and only if approved by the Clinical Home Oxygen Coordinator, COR and/or designee.

10. Emergency Communication System

a. Contractor shall provide a toll-free emergency response system to patient or caregiver that accepts initiated calls 24 hours a day, seven days a week concerning respiratory equipment failures or other problems. Patient must be provided with an emergency contact telephone that is answered by a human being versus an answering machine. The Contractor shall use reasonable, sound judgment in determining whether a true emergency exists that requires immediate attention or whether the problem can be resolved by telephone trouble-shooting with the patient or caregiver. When it is determined that an emergency response is indicated, the Contractor shall take all reasonable actions to meet the patient’s need. Contractor shall respond and provide services in the beneficiaries’ home within two hours. Remote areas could require a longer response time but never more than six hours. If Contractor is unable to respond to an emergency service call within 6 hours, the Contractor is responsible for arranging with another supplier to provide services at the Contractor’s expense. A written explanation of why the Contractor was unable to respond to the emergency must be provided to the COR or designee within two (2) business days.

b. The Contractor shall ensure all patients have at minimum, a non-electrical oxygen supply to last three times the Contractors’ response time to a call. The minimum supply will take into account each patient’s prescription flow-rate and distance from the Contractors location, and so actual supply levels may differ from patient to patient, as long as each patient has oxygen supply to last a minimum of three times the Contractors’ response time. The cost of backup systems including backup oxygen, and backup equipment shall be borne by the

Contractor (with the exception of Ventilators). The Contractor shall furnish an appropriate tank stand for each backup tank/system as indicated at no cost to the government. Liquid oxygen supply may be considered backup oxygen; however, the oxygen supply must be maintained at the minimum three-times the Contractor’s response time, and the cost of any additional equipment such as extra stationary units used solely to maintain the minimum level of backup oxygen shall be borne by the Contractor. The cost of liquid oxygen used solely for backup purposes shall be borne by the Contractor.

c. The Contractor must notify the COR/designated ordering officers and the Clinical Home

Oxygen Coordinator and/or Clinical Ventilator Coordinator immediately when emergency preparedness plan is activated in the event of a disaster, natural or otherwise, that may affect the services covered under this contract. Contact with VA officials may be accomplished electronically or via telephone. Contractor will notify/contact all patients regarding the emergency situation and provide instructions regarding emergency services.

Contractor will provide a written report to the appropriate VA staff of the emergency actions taken and all patients contacted and/or not contacted within two working days.

11. The Contractor shall provide and post on all entrances into the residence, a sign stating

"Warning Oxygen in Use, No Smoking" or other verbiage that NO Smoking is allowed due to oxygen being present and document that the beneficiary/care giver is instructed in the safe use of oxygen and equipment per OSHA. Throughout the life of the contract, the Contractor will monitor and document whether the No Smoking Warning signs are displayed and/or readable.

12. Reports

The Contractor will provide a monthly (5th day after the end of the month) and quarterly summary report (10th day after end of each quarter) meeting all of The Joint Commission’s (TJC) Standards for improving organizational performance (TJC standards may be accessed at http://www.jointcommission.org/). Reports, documentation and billing are submitted in accordance with COR policy at each healthcare system.

i. Incident Report – Reporting special incidents found or occurring during a home visit, to include finding patients in need of emergency medical assistance, safety hazards that do not fall into the category of presenting immediate life-threatening danger to the patient or

Contractors staff, inability to contact a patient within a reasonable period of time, and any other incident meeting the Contractors written policy for incident reporting according to accreditation standards. Usually includes not switching out supplies as instructed, not using equipment as prescribed, not following no smoking policy, smoke alarms not being present or tested, failure to keep scheduled appointments-two consecutive missed or any other unsafe situation or circumstances counter-productive to the Veteran’s home treatment goals.

ii. Customer Satisfaction - In accordance with TJC standards, the Contractor will collect data on service satisfaction from contracted patients and their families from each facility on a quarterly basis. A copy of survey results will be submitted to COR’s or designated ordering officers in Quarterly reports. These reports should report satisfaction of all clients as well as the sub-set of VA contracted clients.

iii. Infection Control/Communicable Diseases – Quarterly report will include data related to the Contractor’s ongoing Infection Control Program, which include recent hospitalizations where a patient was discharged with infectious disease. Hospitalization inquiries should be part of the regular questioning during scheduled visits. VHA will make every attempt to inform contractor if and when it is known that an oxygen patient is discharged meeting this criterion. A current list may also be available from incumbent contractor and available during the transition period.

iv. Performance improvement – The Contractor will collect data on important processes and outcomes related to patient care and organizational functions and other patient-related data as directed for performance improvement and quality purposes. The Contractor will present data in the required format as requested by the VA.

http://www.jointcommission.org/

v. Contractor representative participates as a member (in person or via telephone) of the

Respiratory Home Care Team at each of the healthcare systems. Team meetings are usually quarterly or at the call of the Team Chair or COR.

vi. Dashboard will be submitted electronically per HCS with a summary of all HCS reports sent to the VISN Prosthetic Representative.

Annually Contractor will submit to the COR their Periodic Performance Review for contracted services within 90 days of the end of the annual ordering period. Contractor will assess and score each TJC standards and elements of performance that is applicable to the contracted services by entering a self-assessed score. Any noncompliant findings or gaps in service identified on the self-assessment will require a plan of action to correct as part of the Periodic Performance Review submitted to the COR. The Periodic Performance Review for home care is based upon TJC home care standards may be accessed at http://www.jointcommission.org/

13. The Contractor shall provide the following emergent patient safety notification immediately by telephone and then followed up with written documentation throughout the contract period.

i. Sentinel Events - The Contractor is required to inform the Clinical Home Oxygen

Coordinator/Designee immediately (day of event) of a sentinel event (as defined by TJC) that occurs during the performance of this contract that involves VA beneficiaries.

ii. Refusal of service - All beneficiaries have the right of refusal of service. In the event a beneficiary refuses service or orders the equipment to be removed from the home, the

Contractor shall comply with the beneficiary’s wishes. However, in addition to a written report the Contractor shall report the specific of the refusal to the Clinical Home Oxygen

Coordinator by telephone within one (1) hour. If the refusal occurs during a home visit, the

Contractor’s staff shall attempt to notify Clinical Home Oxygen Coordinator of the refusal during the home visit.

iii. The Contractor’s delivery personnel shall report suspected incidents of abuse or neglect of the patient by family members or caregivers to their company officials. If substantiated, suspected incidents shall be reported immediately (within 24 hours) to Adult Protective

Services (APS). The Contractor will follow all state and local laws in reporting suspected incidents of abuse or neglect. Contractor will inform the Clinical Home Oxygen Coordinator if APS has been contacted.

iv. The Contractor shall immediately notify the Clinical Home Oxygen Coordinator of patients who are non-compliant with smoking.

http://www.jointcommission.org/

14. The Contractor shall be responsible for notifying the COR or designated ordering officers by telephone at time of set-up, if any alteration to the beneficiary's home is necessary to accommodate the oxygen equipment, including electrical work.

The Contractor is responsible for making every effort to establish appointments with VA beneficiaries when initiating set ups and deliveries. Deliveries will not be left unattended at the beneficiary’s home. If the VA beneficiary chronically fails to meet appointments the

Contractor is to notify the COR or designated ordering officers. The COR or designated ordering officers will contact the VA beneficiary and a corrective action plan will be implemented. COR will notify the Contractor of any changes. If the Contractor has not made valid and documented attempts to contact the VA beneficiaries for set ups and or deliveries, the Government reserves the right to call in a third party and bill the Contractor if the Contractor fails to perform for any due month.

15. Infection Control/Communicable Diseases Requirements

a. Contractor must have a current plan for surveillance, prevention and control of infection.

The plan must meet current TJC standards.

b. Contractor will provide a list of names to the Clinical Home Oxygen Coordinator of all

Veteran patients exposed to communicable diseases by contracted staff during an identified incubation period. The type of exposure will also be identified.

c. The Clinical Home Oxygen Coordinator will consult with VA infection control staff regarding the need to contact exposed patients and/or complete any needed medical follow-up.

16. Assessment Requirements

The Contractor shall perform an assessment of the beneficiary’s home and environment in accordance with TJC standards and maintain documentation of assessments in the individual patient file or folder. An oxygen safety risk assessment should be conducted before starting any home oxygen and/or CPAP/BiPAP/NIV/Ventilator/Oxygen therapy in the home. Such assessment documentation for each patient shall accompany the monthly invoice and billing.

a. The Contractor shall verbally notify the Clinical Home Oxygen Coordinator and COR during the home visit if the Contractor’s staff determines that the presence of any

CPAP/BiPAP/NIV/Ventilator/Oxygen respiratory equipment in the home presents such a danger that they must be removed, or in the case of an initial set-up, not placed in the home.

All verbal notification will be documented in the patient folder and faxed to the appropriate

VA facility by the end of the same business day as well as being included within the billing package.

b. The Contractor shall verbally notify the Clinical Home Oxygen Coordinator and COR during the home visit of any unsafe conditions observed in the VA beneficiary’s home that precludes the installation or continuance of any CPAP/BiPAP/NIV/Ventilator/Oxygen respiratory equipment. Unsafe conditions may include, but are not limited to, fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers, or any instance that places the patient or Contractor’s staff in immediate danger. The Contractor shall furnish verbal and written documentation of the safety hazard or the incident. All verbal notification will be documented in the patient folder and faxed to the appropriate VA facility by the end of the same business day as well as being included within the billing cycle.

c. The Contractor will check the adequacy of the electrical outlets in the patient’s home and immediately report unsafe conditions to the Clinical Home Oxygen Coordinator and

COR. VA shall not be responsible or liable for any unsafe electrical conditions caused by the Contractor. Any alterations to the Veteran’s residence will be the responsibility of the

Veteran. If ordered equipment cannot be safely installed, the Clinical Home Oxygen

Coordinator may provide an alternative oxygen delivery system, after documented approval, until new prescription can be obtained. If no alternative is available, the Clinical Home

Oxygen Coordinator and/or the prescribing VA physician will be notified in writing within 24 hours of discovery.

d. The Contractor shall verify the presence of a working smoke detector and the presence of functional fire extinguisher with a full gauge. The Contractor shall document this verification in the patient file and submit documentation with the billing cycle. If the patient does not have a working smoke detector, Contractor will provide per CLIN 28. If there is no functional fire extinguisher the Contractor will strongly advise the patient to obtain one at his or her own expense.

Expectations for Compliance:

1. Consistently look for the presence or absence of a functional smoke detector and fire extinguisher when oxygen is delivered, as well as with subsequent encounters.

If needed:

a. Encourage the patient to have a functional smoke detector if he/she refuses VA offered smoke detector

b. Encourage the patient to have a functional fire extinguisher

c. Provide the patient with information concerning where the absent items can be obtained to include their local fire station

d. Notify the Clinical Home Oxygen Coordinator or prescribing physician in the event that any of these items are missing so they are aware of the safety hazard.

2. When smoke detectors, fire extinguishers and fire safety plans are present:

a. Ask the patient during the initial set-up if they have tested their smoke detectors and checked the condition (charge level) of their fire extinguishers in the last 30 days

b. Ask the patient during each service check visit if they have tested their smoke detectors and checked the condition (charge level) of their fire extinguishers in the last 30 days. If not, document the deficiency in the home care record, notify the

Clinical Home Oxygen Coordinator within 48 hours, and re-educate the patient or caregiver of the importance of fire safety when using oxygen

c. Check all medical equipment provided to home oxygen patients on each service visit to ensure its fire safety. Document in the home care record that this check has occurred.

3. Identify all VA oxygen patients serviced by the Contractor whose homes where the patient or others use smoking materials or there is a potential for open flames such as in heating devices, cooking surfaces, or fireplaces.

a. Within these homes, verify the following:

i. That ‘no smoking’ signage is properly posted,

ii. That the veteran/caregiver has been encouraged to have a functional smoke detector

iii. That the veteran/caregiver has been encouraged to have a functional extinguisher.

iv. Patient and/or caregiver understand and confirm understanding verbalizing the dangers of smoking and open flames while oxygen is present

v. Patient and/or caregiver will avoid smoking or in the presence of flames anywhere near oxygen

vi. Clinical Home Oxygen Coordinator has been notified if patient/caregiver persists or continues to have open flame devices in the vicinity of oxygen,

b. The Contractor shall discuss an Exit Plan with the patient. The Contractor shall ensure the Exit Plan is feasible. The Contractor shall document this discussion about the Exit Plan in the patient file as well as part of the billing cycle.

17. Discontinuation of Service

a. The government shall notify the Contractor in the event of an order to discontinue oxygen or ventilator service to any beneficiary covered under this contract. Notification shall be by telephone, secure e-mail and/or facsimile.

The Contractor shall notify the government within next business day of a patient death, or upon finding a patient has moved out of the service area.

b. The Contractor shall remove equipment from the beneficiary’s residence at the earliest possible time, but no later than five business days unless approved by the Prosthetic

Service. The date and time of equipment pickup shall be coordinated with the patient and/or next of kin and/or significant other. The Contractor shall make every effort to meet the beneficiary’s or beneficiary’s families’ request for pickup times. The Contractor shall honor beneficiary’s or family’s request to pick-up equipment before or after funerals or family gatherings, relative to beneficiary funerals. The Contractor shall treat such requests with the utmost courtesy and give such requests the highest priority.

c. Patients relocating out of VISN 17’s primary service area will be allowed to take all equipment, cylinders and supplies with them to their new place of residence. The patient will be provided with enough oxygen and supplies to sustain them for 30-45 days to permit enrollment into the receiving healthcare system. The Contractor will coordinate with the local Contractor in the new area for the return of Contractor and/or Government owned equipment, shipping and related charges at no additional cost to the government. The

Veteran may be provided with a vendor owned portable concentrator while relocating to their new primary service area. A prescription will be provided to Vendor to change equipment if appropriate.

18. Employee Certification

a) The Contractor shall develop, maintain, and make available for review, personnel folders on all employees performing under this contract.

b) Contractor must provide and document employee orientation, ongoing employee education, and ongoing assessment of employee competency for all employees involved with the delivery/recovery of equipment covered under this contract according to TJC standards.

c) The Contractor will provide COR or designated ordering officers with a list of all employees currently competent to perform licensed respiratory therapy services, delivery/recovery and patient education services at the time the contract is awarded. COR or designated ordering officers will inspect employee files at the time of the inspection of

Contractor premises and vehicles.

d) The Contractor will provide all required documentation of certification and/or registry from the National Board for Respiratory Care (NBRC) and a valid State license for all

Respiratory Therapist personnel utilized under this contract. This documentation shall be provided for each State that is serviced under this contract. Therapist must have a minimum of one (1) year working experience with ventilator dependent patients.

e) The Contractor will educate, evaluate and document employee education in strict accordance with current TJC accreditation standards.

f) Only employees that have been properly trained and who have demonstrated competency may perform equipment deliveries, recoveries, and patient education on the equipment.

g) The Contractor shall be staffed and have sufficient supplies to render satisfactory and courteous service at all times to the beneficiary. The Contractor shall be responsible for the acts and omissions of his/her employees.

19. Equipment: Contractor shall install and service all CPAP/BiPAP/NIV/Ventilator/Oxygen respiratory equipment and dispense CPAP/BiPAP/NIV/Ventilator/Oxygen respiratory equipment ordered under this contract. All Contractor owned equipment is to be current state-of-art model and all supplies are to be new. A label with the Contractor’s name and emergency telephone number where they can be reached 24 hours/day will be affixed to all equipment (VA and

Contractor owned). Contractor shall provide collars that will reflect the tank is specifically for back up use only. This collar will be provided by the Contractor at no expense to the VA. Contractor will not service, move, assess or be responsible for any equipment that is privately owned, owned by another vendor, or otherwise not owned by the Veterans Medical Center.

a) The installation of all machines and equipment by the Contractor shall be performed by a competent professional familiar with nature of the equipment involved and fully qualified under the laws of the State in which the services are being rendered. Installation shall be consistent with current local Fire and Safety Codes in the respective area of the State and shall conform to NFPA 99/101 (Life Safety Codes) and NFPA (Oxygen Cylinder

Requirements). The Contractor shall provide a safety/emergency checklist to be completed, then signed by the Veteran or his/her caregiver and retained in the beneficiary account folder as well as submitted as part of the billing cycle. The

Contractor shall ensure that all equipment is checked at manufacturer recommended intervals. A Contractor’s staff member will conduct a check of the concentrator using a certified oxygen analyzer that is calibrated according to the manufacturer standards.

Preventative maintenance on equipment shall be done by a manufacturer’s checklist. It shall include compressor inlet pre-filter changes and compressor inlet bacteria filter changes according to the manufacturer recommendations. The alarm battery shall be tested at each maintenance check, changed as indicated but at least annually. The

Contractor is responsible for tracking and documenting maintenance of equipment in accordance with manufacturer specifications and providing these records for review upon request. Price estimates will be submitted before any preventative maintenance is done. Records will be kept of maintenance performed showing the make, model and serial number of units, date of service, itemized list of materials, parts and labor. The

Contractor shall have recall procedures for equipment and supplies.

b) Contractor shall insure appropriate static testing on VA owned tanks will be conducted

(CLIN 0021). Each cylinder bearing a DOT specification marking (including a cylinder remarked in conformance with 49 CFR §173.23) must be inspected, retested and marked in conformance with this section, at the frequency specified in the Retest and

Inspection of Cylinders Table. Each cylinder bearing a DOT exemption number must be inspected, retested and marked in conformance with this section and the terms of the applicable exemption, at the frequency specified in the exemption.

c) The Contractor shall not change or alter a VA beneficiary’s oxygen or ventilator prescriptions or equipment requirements without a new prescription from the beneficiary’s

VA Pulmonary or specialty physician submitted by the Clinical Home Oxygen Coordinator, Clinical Specialty Coordinator (ventilators), COR or designated ordering officers. The

Contractor will provide items and services as authorized by the government.

d) Transition Period: At the end of the contract period, a transition period will be required during which incumbent Contractor will continue to provide services at the contract prices while the incoming Contractor is taking over. This period will be approximately 90 days.

There will be daily communication between the outgoing vendor, incoming vendor and VA to ensure a smooth transition.

20. EQUIPMENT SPECIFICATIONS

Standards and guidelines are as follows:

a. The American Respiratory Care Foundations for Respiratory Equipment Used in the

Home.

b. American Society for Testing Materials (ASTM) minimum standards specification for electrically powered home care portable ventilators.

c. Association for the Advancement of Medical Instrumentation (AAMI).

d. The Joint Commission Standard for Home Care/CMS, current year standard.

The oxygen concentrators shall be Underwriter Laboratory (UL) approved and must at a minimum meet the following specifications:

• Electrically powered (115 volts).

• There shall be a battery-operated audible alarm to indicate a power failure.

• The oxygen concentrator shall not perform below the manufacturer’s specification.

• Hour meter and OCI indicator

• The oxygen concentrator shall be grounded internally or plug into a three-prong wall outlet appropriate for the VA beneficiary’s home (outlet adaptors are not acceptable).

• All electrically powered equipment used in performance of this contract shall be UL approved and shall be the most recently developed in the field at the time of use.

• Oxygen provided must be United States Pharmacopoeia (U.S.P.) oxygen.

• Government-owned equipment shall be maintained per manufacturer’s specifications.

Contractor owned equipment shall be repaired or replaced at no cost to the Government when breakdown or malfunction is due to normal usage or due to the fault of the

Contractor.

• Government-owned equipment will be terminally cleaned, maintained and repaired by

Contractor. COR will be notified when VA owned equipment can no longer be repaired in-house by Contractor. If repairs require third-party repairs by manufacturer certified/qualified technicians, contractor shall swap out equipment, request approval by COR to request quotes from third-party repair shops and send estimates to COR for approval prior to repairs being made. Minor repairs include any repairs that can be done in-house by contractor which do not require specialized or manufacturer certified personnel to accomplish. Complex repairs include those which cannot reasonably be accomplished by contractor due to need for specialized equipment or repairs that may only be done by manufacturer or certified third-party repair specialists. Complex repairs shall be approved by COR prior to repair work being done and will be reimbursed based on fair and reasonable estimates received from contractor.

21. CYLINDERS: The Contractor shall furnish cylinders (other than those associated with the trans-fill system) called for under this contract that are only in accordance with the Interstate

Commerce Commission Regulations, and transport cylinders in accordance with Code of Federal

Regulations (CFR) Part 49, U.S. Department of Transportation. ‘H’, ‘K’, or ‘M’ cylinders furnished by the Contractor shall have ‘H’, ‘K’ or ‘M’ safety stand at no additional charge to the Government.

This stand shall remain Contractor-owned.

22.